No, that’s not an olive. That’s Pyloric Stenosis!

Inspired by what appears to have been a very interesting day in the Peds ED, lets review a rare but interesting pediatric entity: PYLORIC STENOSIS Background: MC in Males (5:1) & firstborn children (30%) Usually begin between 3-6 wks of age, rarely after 12 wks Clinical Presentation: Nonbilious emesis. Early, patient will be hungry andRead more

Put down that FOBT

“The HgB has dropped, have you checked a guaic?” How many times have you checked a FOBT in your workup for anemia? Let’s take a look at what FOBT is supposed to be used for. FOBT is a visual stool assay in which heme in the stool reacts with reagent hydrogen peroxide to oxidize guaiac, leadingRead more

Troubleshooting PEG tubes

A patient is sent from nursing home at 10pm for a non-functioning PEG tube. He has a prior history of stroke with L sided weakness and is now bedbound at baseline. He has stable vitals, no abdominal tenderness, and is otherwise well appearing. What do you do next? You could call GI to help, butRead more

NEC, volvulus, pyloric stenosis, oh my!

This is a review of specific pediatric entities that may cause abdominal pain, bloody diarrhea, or vomiting. The following lists are not comprehensive and emergency physicians should consider a broad differential based on symptoms and presentation. The aim of this pearl is to familiarize us with these select pediatric conditions. Case courtesy of A.Prof FrankRead more

Imaging in Intussusception

Clinical Scenario: A 2-year-old female with no significant past medical history presents with vomiting and abdominal pain for 1 day. Among other entities in your differential diagnosis you are considering intussusception, however it is lower on your differential. How would you work-up this child?   Presenting Symptoms for Intussusception1 Sudden onset of intermittent, severe, crampy,Read more

Imaging in Clostridium difficile infection

Clinical Scenario: A 68-year-old man with a past medical history of diabetes mellitus, hypertension, and recent admission for pneumonia presents with fever and diarrhea for 5 days. The patient has had multiple watery stools per day. Associated symptoms include mild vague abdominal pain but no nausea or vomiting. Exam is notable for mild diffuse abdominalRead more

52 in 52: Nasogastric tube in GI bleeds

Article Citation: Palamidessi N, Sinert R, Falzon L, Zehtabchi S. Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis. Acad Emerg Med. 2010 Feb;17(2):126-32. PMID: 20370741 What we already know about the topic: Nasogastric aspiration and lavage for patients with melena or hematochezia to localize GI bleed is controversial. Supporters argue thatRead more

Just a simple guaiac test….but what makes it tick?

Lets be honest: whether you like it or not, it’s a rare day working in the ED when you don’t guaiac someone. To “guaiac them” is of course slang for performing a point of care fecal occult blood test. Its a valuable tool and can yield useful clinical information when used appropriately. But do youRead more

A Novel Idea for Airway Management

A 65 yo M is rushed into the resus room. He is pale and is vomiting a mixture of coffee ground emesis and bright red blood. His vitals are stable currently but he is continuing to vomit in the emergency department. This patient requires a definitive airway. You have studied the emcrit guidelines for intubatingRead more

LLQ abdominal pain

A 43 yo M presents with LLQ abd pain, non-bloody diarrhea and subjective fever for 1 d. His vitals are normal, has a WBC of 14 but otherwise normal labs.  He is given IV analgesia and clinically has improved, tolerating PO.  CT abdomen and pelvis shows diverticulitis without evidence of abscess or perforation. Time to pullRead more